Wednesday, February 17, 2010

Are There Racial Differences in Pelvic Organ Prolapse?

Racial differences exist for certain diseases which are well known: diabetes, high blood pressure and prostate cancer may be more aggressive or more difficult to treat in American blacks. So researchers asked if racial differences exist as well in regards to pelvic organ prolapse.

Pelvic organ prolapse (POP) is very prevalent and can lead to many health-related issues. Certain risk factors are well known, such as childbirth, hysterectomy, menopause, and familial. A large population-based study conducted by Kaiser looked at over 2,200 middle aged and older women. Data was all self-reported by the women in the survey who then underwent an exam.

What were the findings?

Certain conditions were shown again to be associated with POP such as: prior hysterectomy, menopause, chronic cough from bronchitis/emphysema, and weekly urinary incontinence. Race/ethnicity was also found to be relevant. Even though degree of prolapse was similar across all race groups, White and Latina compared to Black women were associated with symptomatic prolapse. Latina women were most bothered with 41% reported moderate to extreme bother, with 20% of white women, 20% Asian women, and 17% of black women. Factors that were independently associated with the leading edge of the prolapse being at/beyond the hymen and stage of prolapse (objective prolapse) were white vs. black race, age, BMI and vaginal delivery, and diabetes.

Even though the degree of prolapse was the same across all groups, Latina and white women had more subjective complaints about their prolapse. The study authors suggest there may be cultural differences in attitudes towards the condition or in tendency to report it. To me this suggests that a thorough history and physical exam is always good medicine in order to properly diagnose pelvic health conditions.

Sunday, February 7, 2010

Kidney Stones & Pregnancy

On its own, a kidney stone attack is one of the most painful events described by patients. My female patients always declare that the pain from a kidney stone is worse than childbirth. When a kidney stone drops and causes pain during pregnancy, it presents a unique challange. Care for patient must be balanced with preventing harm to the fetus or premature labor. Often, conservative treatment is successful in charaponing the patient through her pregnancy, and sometimes the patient will pass the stone even prior to delivery. Other times, intervention is required.

To read more on it, please visit my latest article in online journal The Female Patient at:
http://www.femalepatient.com/

Thursday, February 4, 2010

Does Yoga Improve Female Sexuality?

Female Sexual Dysfunctions (FSD) are common and often do not get the attention necessary since the topic may be of embarrassment to the female patient or physician. FSD is usually categorized into 4 major groups: Low Sexual Desire, Low Arousal, Lack of Orgasm, and Pain and must cause distress to the woman. At the present time, there are limited medication treatments for FSD, and current therapies are generally limited to hormone replacement (estrogen or testosterone), local creams, herbals, couples counseling, and lifestyle changes. Any one of the FSDs can lead to low physical and emotional satisfaction.

A recent study looked at whether yoga has a positive effect on FSD, since it is becoming widely popular in Western societies. 22 different positions were evaluated. Some common ones were: Kapalbhati, Yog mutra, Halasan, Dhanurasan and Chakarasan. Yoga was advised to be performed for an hour twice a day, or as much as the participants could tolerate. Three repetitions of each pose was suggested. After yoga was completed differential relaxation with slow breathing and relaxing the muscles that were just stretched was performed.

All domains of FSD were improved: Desire, arousal, lubrication, orgasm, satisfaction and pain, with an overall improvement of nearly 20% of all these domains collectively. Overall, 72% of women reported improvement in satisfaction about their sexual life after yoga. Women over 45 years old noticed more improvement versus those under 45. The greatest improvement seen in women over 45 was in arousal and pain, and the least improvement was in desire. In women under 45 years old, the greatest improvement was in orgasm and satisfaction, and the least improvement was desire. Lubrication and pain also improved significantly in women older than 45 years.

What is it about yoga that has a positive effect on FSD?

Yoga is known to have beneficial effects on lumbar muscle tone, depression, high blood pressure, peripheral neuropathy, anxiety, joint disease, stress, labor pain, epilepsy, pain, addiction, infertility, psychosomatic disorders, obsessive-compulsive disorder and quality of life overall. In general, stress reduction appears to be a common thread, as well as improved blood flow from stretching. Although, it is not known exactly how long yoga must be performed in order to achieve improvement in FSD, but it can be said that improvements can be made in FSD over time. Considering the non-pharmacological nature of yoga, there is little reason to not try it if FSD exists.